Citation Nr: 21076332 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 17-03 244 DATE: December 23, 2021 ORDER A disability rating of 50 percent, but no higher, for bipolar disorder is granted. FINDING OF FACT Resolving all doubt in the Veteran's favor, the severity, frequency, and duration of her psychiatric symptoms more closely approximate occupational and social impairment with reduced reliability and productivity due to such symptoms as panic attacks more than once a week and difficulty in establishing and maintaining effective work and social relationships; they did not more closely approximate occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for a disability rating of 50 percent, but no higher for bipolar disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9432. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1991 to July 1991. This appeal comes to the Board of Veterans' Appeals (Board) from a September 2016 rating decision of the Department of Veterans' Affairs (VA) regional office (RO). This case was previously before the Board in August 2021, at which time the issues currently before the Board were remanded for additional development. The case has now been returned to the Board for appellate review. Increased Rating Bipolar disorder The Veteran is currently in receipt of a 30 percent disability rating for her service-connected bipolar disorder. She asserts that she should have a higher rating for her bipolar disorder as her symptoms are worse than those contemplated by the currently assigned rating. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent. In both the NOD and the VA Form 9, the Veteran indicated that she sought, and her belief that her symptoms warranted, a 50 percent disability rating. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Resolving all doubt in the Veteran's favor, the Board finds that an award of an increased 50 percent disability rating for bipolar disorder is warranted. Although VA examiners in July 2016 and September 2021 opined that the Veteran's psychiatric symptoms were best summarized as resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation, neither opinion explains what consideration the examiners gave, if any, to the Veteran's reported daily panic attacks and crying spells. Such reports are documented in the Veteran's VA treatment records throughout the relevant appeal period. Additionally, she has described difficulties trusting people and in maintaining effective friendly and romantic relationships. Considering the evidence of record as a whole, the Board finds that the severity and overall effect of the Veteran's symptoms may be viewed as approximating that contemplated by a 50 percent evaluation. See 38 C.F.R. § 4.130, Diagnostic Code 9432. Therefore, the Veteran's appeal is granted to that extent. The Board has further considered whether a rating in excess of 50 percent may be warranted for any portion of the appeal period. However, the Veteran has not asserted, and the record does not otherwise indicate, that she experienced the symptoms listed under the 70 percent criteria, or other symptoms of a comparable severity, frequency, and duration as would result in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood. Thus, an award in excess of 50 percent for service-connected bipolar disorder is not found warranted. The preponderance of the evidence weighing against such an award, there is no doubt to resolve in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3, Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. SOLOMON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Umez-Eronini, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.